Answer to Image of the Month November 2014

Submitted by Avninder Singh


Well’s syndrome

Well’s syndrome is a disease of unknown pathogenesis and is characterized by a tissue reaction pattern known as ‘eosinophilic cellulitis with flame figures’. Clinically, it shows edematous and erythematous indurated plaques resembling cellulitis and often may show blister formation. There is no age predilection but the preferred sites are on extremities and trunk. Though most cases are idiopathic, some are associated with insect bites, parasitic infestation or drug allergies.

On histology, the skin biopsy shows an inflammatory reaction in the entire dermis and consists of eosinophils and histiocytes. The hallmark is the ‘flame figure’ which are deposits of degranulated eosinophilic granules, major basic protein encrusted upon the normal collagen. Sometimes these figures are surrounded by a palisade of histiocytes. This type of tissue reaction may also be seen in bullous pemphigoid, arthropod reaction, parasitic infestations, allergic eczemas and internal malignancies.